Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | CNP191268 | ME |
NPI | 1003459231 |
---|---|
Provider Name | Alicia Lyn Soucy |
First Address | Fort Kent, ME 04743-1428 |
Second Address | Fort Kent, ME 04743-1428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2019 |
Last Update Date | 21/10/2019 |